US Vaccine Research Articles

Multivariate Analysis as a Method to Evaluate Antigenic Relationships between Bovine Viral Diarrhea Virus 1b Isolates and Vaccine Strains.

The antigenicity of bovine viral diarrhea virus (BVDV) has been evaluated using virus-neutralizing titer data analyzed by principal component analysis (PCA) and has demonstrated numerous isolates to be antigenically divergent from US vaccine strains. The lack of BVDV-1b strains in currently licensed vaccines has raised concerns regarding the lack of protection against BVDV-1b field strains. The aim of this study was to evaluate the antigenic diversity of BVDV-1b strains and better understand the breadth of antigenic relatedness using BVDV-1b antisera and antisera from vaccine strains. Results from this analysis demonstrate the antigenic diversity observed among BVDV-1b isolates and genetic assignment into the BVDV-1b subgenotype is not representative of antigenic relatedness. This is demonstrated by BVDV-1b isolates (2280N, SNc, Illc, MSU, and 2337) observed to be as antigenically dissimilar as BVDV-2a isolates when using BVDV-1b antisera. Additionally, when BVDV-1a vaccine antisera was used for comparisons, a greater percentage of BVDV-1b isolates clustered with BVDV-1a vaccine strains as part of PC1, suggesting antigenic relatedness and potentially partial protection. Collectively, data from this study would suggest that while most BVDV-1b isolates are antigenically similar, there are antigenically dissimilar BVDV-1b isolates as determined by the lack of cross-reactivity, which may contribute to the lack of protection.

The Political Influence of US and China Vaccine Competition in Southeast Asia on Potential New Security Issues for ASEAN Countries

Vaccine competition between the United States and China in Southeast Asia has been potential to create new security problems for ASEAN member states. Based on the constructivism perspective and Regional Security Complex Theory (RSC), this article analyses the relationships between the identity and interest of both states, US and China, who took certain policies and engaged in the vaccine competition in the Southeast Asian region. China with the political manoeuvre and US with the humanitarian endeavour in their narration, both had interests in terms of economic, politics, also geopolitics through their assistance to ASEAN countries. The authors argue that new security problems, such as the rising unemployment rates, the declining GDP, and the new pandemic wave, caused by this competition are the result of the absence of collective identity of ASEAN countries. Instead of prioritizing their collective identity as a regional community and forming regional security complex, ASEAN countries tend to respond by prioritizing their respective national interests. Therefore, this article offers the recipes where ASEAN member state should establish their collective identity, such as supporting the development of ASEAN vaccines in Vietnam and Thailand or establishing the ASEAN pharmaceutical company designates as the regional vaccine research and development site.

Safety profile of paediatric COVID-19 vaccines: An analysis of the US Vaccine Adverse Event Reporting System.

To provide further evidence on the safety profile of COVID-19 vaccines in paediatrics by analysing the spontaneous reports of adverse effects related to these vaccines. Reports related to US paediatric population (from 0 to 17 years) vaccinated with authorised COVID-19 vaccines were extracted from Vaccine Adverse Event Reporting System from December 2020 to 17 November 2022. We conducted a descriptive analysis of Adverse Events Following Immunization (AEFI), calculating reporting rate of serious AEFIs and focusing on myocarditis and Guillain-Barré Syndrome after mRNA COVID-19 vaccines. Overall, 52 720 reports were retrieved: 77% (40541)-Pfizer-BioNTech, 19% (10083)-Moderna, a small proportion for other vaccines 4% (2096). Most of AEFIs were non-serious and listed in corresponding SPCs. Of serious AEFIs, 96% were related to the Pfizer-BioNTech vaccine. Roughly 91% (47874) were related to people from 6 to 17 years, a small percentage of 9% (4773) to the younger group (0-5 years). In both groups, most of the reports were related to mRNA vaccines and the percentage of AEFIs experienced by females were similar to males. Data showed that events most frequently reported were non-serious and listed in the corresponding SPCs, extending the evidence of safety of COVID-19 vaccines authorised in the United States in children.

Computer-assisted identification of potential quinolone derivatives targeting Nipah virus glycoprotein attachment with human cell surface receptor ephrin-B2: Multistep virtual screening

Nipah Virus (NiV) is a single-stranded, negative-sense, highly lethal RNA virus. Even though NiV has close to 70–80% of mortality in India and Bangladesh, still there is no available US FDA-approved drug or vaccine. NiV attachment glycoprotein (NiV-G) is critical for NiV to invade the human cell where ephrinB2 which is a crucial membrane-bound ligand that acts as a target of NiV. Most of the research has been performed targeting NiV or human ephrin-B to date. Quinolone derivatives are proven scaffolds for many approved drugs used to treat various bacterial, viral respiratory tract, and urinary tract infections, and rheumatologic disorders such as systemic lupus erythematosus, rheumatoid arthritis. Therefore, we have tried to find potential drug molecules employing quinolone scaffold-based derivatives from PubChem targeting both NiV-G and ephrin-B2 protein. A total of 1500+ quinolone derivatives were obtained from PubChem which were screened based on Drug Likeness followed by being subjected to XP docking employing Schrödinger software. The top ten best molecules were then chosen for their absorption, distribution, metabolism, excretion, and toxicity (ADMET) profiling based on the docking score ranking. Further, the top five molecules were selected for 200ns molecular dynamics (MD) simulation study with Desmond module followed by MM-GBSA study by Prime module of Schrödinger. The exhaustive analysis leads us to the top three probable lead drug molecules for NiV are PubChem CID 23646770, an analog of PubChem CID 67726448, and PubChem CID 10613168 which have predicted Ki values of 0.480 μm, 0.785 μm, and 0.380 μm, respectively. These proposed molecules can be the future drugs targeting NiV-G and human ephrin-B2 which requires further in vivo validation.

Multivariate analysis reveals that BVDV field isolates do not show a close VN-based antigenic relationship to US vaccine strains

ObjectiveEvaluate bovine viral diarrhea virus (BVDV) antigenicity by using virus neutralization titers (VNT) analyzed using the principal component analysis (PCA) from antisera generated against US-based vaccine strains against both US-origin field isolates and non-US-origin field isolates.ResultsData from both independent analyses demonstrated that several US-origin and non-US-origin BVDV field isolates appear to be antigenically divergent from the US-based vaccine strains. Results from the combined analysis provided greater insight into the antigenic diversity observed among BVDV isolates. Data from this study further support genetic assignment into BVDV subgenotypes, as well as strains within subgenotypes is not representative of antigenic relatedness. PCA highlights isolates that are antigenically divergent from members of the same species and subgenotype and conversely isolates that belong to different subgenotypes have similar antigenic characteristics when using antisera from US-based vaccine isolates.

The impact of immunotherapies on COVID-19 case fatality rates during the US vaccination campaign: a multidisciplinary open data analysis using FDA Adverse Event Reporting System and Our World in Data.

Introduction: Patients under immunotherapies were excluded from the pivotal trials of vaccinations against the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), and no population-level data on disease outcomes such as case fatality rates in relation to vaccination coverage exist. Our study aims to fill this gap by investigating whether CFRs in patients with immunotherapies decrease with increasing vaccination coverage in the total population. Methods: We combined aggregated open source data on COVID-19 vaccination coverage from "Our World in Data" with publicly available anonymized COVID-19 case reports from the FDA Adverse Event Reporting System to compute COVID-19 CFRs for patients under immunotherapy at different vaccination coverage levels in the total population. CFRs at different vaccination coverage levels were then compared to CFRs before vaccination campaign start. Results: While we found an overall decrease in CFRs on population level with increasing vaccination coverage, we found no decrease in people using anti-CD20 or glucocorticoids. Discussion: Risk-mitigation strategies on an individual- and population-level are thus still needed to lower the probability of fatal SARS-CoV2 infection for these vulnerable populations.

Imprecision in vaccine adverse event reporting and a methodological analysis of reporting systems to improve pharmacovigilance and public health.

This study documents imprecision in Japanese reports of adverse events following immunization (AEFI). In doing so, it presents methods to analyze this imprecision. These methods include use of unique Japanese data on the validity of certain AEFIs. They also include ways to estimate AEFI rates, which allow comparison of AEFI data between countries. Using US AEFI data for comparison, we show how differences in AEFI reporting systems likely influence AEFI statistics. Although our comparisons of AEFI rates are not precise, many of the difference we detected between Japanese and US statistics make sense and reflect differences in the societal and medical perspectives on various vaccines or can be explained by differences in the reporting systems including reporting sources. For example, differences in societal and medical perspective probably underly the extraordinarily high Japanese rates of anaphylaxis and other AEs following HPV immunizations from 2010 to 2016 compared to US rates and to Japanese rates for other vaccines. High US rates of reported Guillain-Barré syndrome following influenza vaccination relative to Japanese rates and to rates for other US vaccines are consistent with data suggesting that the index of suspicion for such reactions could affect AEFI rates. The findings that over half of Japanese anaphylaxis reports for every vaccine are erroneous, and that close to half of "serious" Japanese AEFI cases probably are not serious may be due in part not only to explanations unique to Japan, but also to factors that apply to the USA and other countries. Differences in reporting systems account for a much higher rate of non-serious AEFI reports in the USA compared to Japan. Japanese marketing authorization holders are probably at least as assiduous and timely in their reporting of AEFIs as health care providers, though granular level differences are apparent in reporting by various sources. The methods we used to analyze the validity of Japanese statistics can be used to analyze the validity of AEFI reports from other countries and aid the harmonization of adverse event reporting systems. Eventually, similar reporting systems might be adapted for drugs and medical devices.

COVID-19 Vaccine Safety First Year Findings in Adolescents.

The Food and Drug Administration expanded Emergency Use Authorization for use of Pfizer-BioNTech (BNT-162b2) coronavirus disease 2019 vaccine to include people ages 12 years and older on May 10, 2021. We describe adverse events observed during the first full year of the US coronavirus disease 2019 vaccination program for adolescents ages 12 to 17 years. We conducted descriptive analyses using data from 2 complementary US vaccine safety monitoring systems: v-safe, a voluntary smartphone-based system that monitors reactions and health impacts, and the Vaccine Adverse Event Reporting System (VAERS), the national spontaneous reporting system. We reviewed reports and calculated adverse event reporting rates using vaccine administration data. Among 172 032 adolescents ages 12 to 17 years enrolled in v-safe, most reported reactions following BNT-162b2 were mild to moderate, most frequently reported on the day after vaccination, and more common after dose 2. VAERS received 20 240 adverse event reports; 91.5% were nonserious. Among adverse events of interest, we verified 40 cases of multisystem inflammation syndrome in children (1.2 cases per million vaccinations), 34 (85%) of which had evidence of prior severe acute respiratory syndrome coronavirus 2 infection; and 570 cases of myocarditis (17.7 cases per million vaccinations), most of whom (77%) reported symptom resolution at the time of report. During the first year BNT-162b2 was administered to adolescents ages 12 to 17 years, most reported adverse events were mild and appeared self-limited. Rates of myocarditis were lower than earlier reports. No new serious safety concerns were identified.

The Covid-19 pandemic and the expansion of the mortality gap between the United States and its European peers.

The mortality gap between the United States and other high-income nations substantially expanded during the first two decades of the 21st century. International comparisons of Covid-19 mortality suggest this gap might have grown during the Covid-19 pandemic. Applying population-weighted average mortality rates of the five largest West European countries to the US population reveals that this mortality gap increased the number of US deaths by 34.8% in 2021, causing 892,491 "excess deaths" that year. Controlling for population size, the annual number of excess deaths has nearly doubled between 2019 and 2021 (+84.9%). Diverging trends in Covid-19 mortality contributed to this increase in excess deaths, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. In 2021, the number of excess deaths involving Covid-19 in the United States reached 223,266 deaths, representing 25.0% of all excess deaths that year. However, 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 is due to other causes of deaths. While the contribution of Covid-19 to excess mortality might be transient, divergent trends in mortality from other causes persistently separates the United States from West European countries. Excess mortality is particularly high between ages 15 and 64. In 2021, nearly half of all US deaths in this age range are excess deaths (48.0%).

A two-regime analysis of the COVID-19 vaccine distribution process

PurposeThe purpose of this paper is to develop a framework to evaluate and assess the performance of the COVID-19 vaccine distribution process that is sensitive to the unique supply-side and demand-side constraints exhibited in the US vaccine rollout.Design/methodology/approachA queuing framework that operates under two distinct regimes is formulated to analyze service rates that represent system capacity to vaccinate (under the first regime) and hesitancy-induced throughput (under the second regime). These supply- and hesitancy-constrained regimes form the focus of the present paper, as the former reflects the inherent ability of the nation in its various jurisdictions to mobilize, whereas the latter reflects a critical area for public policy to protect the population’s overall health and safety.FindingsThe two-regime framework analysis provides insights into the capacity to vaccinate and hesitancy-constrained demand, which is found to vary across the country primarily by politics and region. The framework also allows analysis of the end-to-end supply chain, where it is found that the ability to vaccinate was likely constrained by last-mile administration issues, rather than the capacity of the manufacturing and transportation steps of the supply chain.Originality/valueThis study presents a new framework to consider end-to-end supply chains as dynamic systems that exhibit different regimes because of unique supply- and demand-side characteristics and estimate rollout capacity and underlying determinants at the national, state and county levels.

Debt to the Penny and US Dollar Index: a lead-lag relationship of the US economy under impacts of the Covid-19 outbreak

PurposeThis study investigates the interactions between the US daily public debt and currency power under impacts of the Covid-19 crisis.Design/methodology/approachThe authors employ the multivariate generalized autoregressive conditional heteroskedasticity (MGARCH) modeling to explore the interactions between daily changes in the US Debt to the Penny and the US Dollar Index. The data sets are from April 01, 1993, to May 27, 2022, in which noticeable points include the Covid-19 outbreak (January 01, 2020) and the US vaccination campaign commencement (December 14, 2020).FindingsThe authors find that the daily change in public debt positively affects the USD index return, and the past performance of currency power significantly mitigates the Debt to the Penny. Due to the Covid-19 outbreak, the impact of public debt on currency power becomes negative. This effect remains unchanged after the pandemic. These findings indicate that policy-makers could feasibly obtain both the budget stability and currency power objectives in pursuit of either public debt sustainability or power of currency. However, such policies should be considered that public debt could be a negative influencer during crisis periods.Originality/valueThe authors propose a pioneering approach to explore the relationship between leading and lagging indicators of an economy as characterized by their daily data sets. In accordance, empirical findings of this study inspire future research in relation to public debt and its connections with several economic indicators.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2022-0581

Institutional trust, scientific literacy, and information sources: What factors determine people's attitudes toward COVID-19 vaccines of different origins in China?

This study aimed to investigate the different attitudes of Chinese residents toward COVID-19 vaccines produced in China and the United States in an emergency context, and then explored possible explanations for these different attitudes. Using data collected online in May 2021, we compared Chinese citizens' attitudes toward vaccines originating from China and the US and then adopted ordered logistic models to examine how trust in institutions, scientific literacy, and information sources influence their attitudes toward different vaccines. A total of 2038 respondents completed the survey. Participants reported very different levels of trust in Chinese and American vaccines. The main finding of this paper is that individuals who trust in Chinese institutions, especially those who trust in domestic scientists, typically feel encouraged to also place their trust in domestic vaccines and to distrust those from the US. These individuals' higher evaluation of Chinese government performance makes them more willing to vaccinate with domestic vaccines and less likely to seek US vaccines. Levels of scientific literacy, furthermore, seem to have little influence on attitudes toward different vaccines. Meanwhile, respondents who acquire health information from biomedical journals are more likely to hold a positive view of US vaccines, and these individuals contribute to bridging the gap between levels of trust in Chinese and US vaccines. In contrast with previous findings about Chinese attitudes toward imported vaccines, our respondents are more convinced of the safety and effectiveness of domestic vaccines than of US ones. This trust gap does not arise out of actual disparity in the quality and safety of the different vaccines per se. Instead, it is a cognition concern that is closely bound up with individuals' trust in domestic institutions. People's attitudes toward vaccines of different origins in an emergency context are more influenced by socio-political beliefs than by concern with objective information and knowledge.

ASSESSMENTS OF U.S. COVID-19 VACCINE DIPLOMACY AND BENEFITS FOR VIETNAM

The COVID-19 pandemic originated in Wuhan, China in December 2019. Since then, it has rapidly widespread in almost every country around the world and has become a new global public health crisis. Since then, the demand for coronavirus vaccines and the supply of vaccine production becomes the most urgent strategic priority issues globally. Many governments have participated in the race of coronavirus vaccine production and distribution typically as the United States, China, Russia, and Australia. The United States marks as the leading vaccine supplier in this race. This country has delivered more than 682 million COVID-19 vaccine doses, all donated free of charge, to 116 countries - more doses than any other nation. The objective of the article is to analyze the vaccine diplomacy of the US base on the vaccine donation dataset, the location where the vaccine was given. The article indicates that the US has taken the lead in the race to produce and supply vaccination to the world. Vietnam, as a comprehensive partner of the US, has benefited from the US vaccine diplomacy policy. The paper has shown that the US. has given a significant amount of medical support and vaccines to Vietnam. These contribute significantly meaning for Vietnam's COVID-19 fighting.

The political component of COVID-19 vaccine choice: Results from a conjoint experiment

ObjectivesPrior research highlights the role of efficacy, vaccine safety, and availability in vaccine hesitancy. Research is needed to better understand the political driving forces behind COVID-19 vaccine uptake. We examine the effects of the origin of a vaccine, and approval status within the EU on vaccine choice. We also test if these effects differ by party affiliation among Hungarians. Study designWe use a conjoint experimental design to assess multiple causal relationships. Respondents choose between two hypothetical vaccine profiles randomly generated from 10 attributes. The data were gathered from an online panel in September 2022. We applied a quota for vaccination status and party preference. Three hundred twenty-four respondents evaluated 3888 randomly generated vaccine profiles. MethodsWe analyse the data using an OLS estimator with standard errors clustered by respondents. To further nuance our results, we test for task, profile, and treatment heterogeneity effects. ResultsBy origin, respondents prefer German (MM 0.55; 95% CI 0.52–0.58) and Hungarian (0.55; 0.52–0.59) vaccines over US (0.49; 0.45–0.52) and Chinese vaccines (0.44; 0.41–0.47). By approval status, vaccines approved by the EU (0.55, 0.52–0.57) or pending authorization (0.5, 0.48–0.53) are preferred over unauthorised ones (0.45, 0.43–0.47). Both effects are conditional on party affiliation. Government voters especially prefer Hungarian vaccines (0.6; 0.55–0.65) over others. ConclusionsThe complexity of vaccination decisions calls for the usage of information shortcuts. Our findings demonstrate a strong political component that motivates vaccine choice. We demonstrate that politics and ideology have broken into fields of individual-level decisions such as health.

Historical Lessons on Vaccine Hesitancy: Smallpox, Polio, and Measles, and Implications for COVID-19.

Vaccine hesitancy continues to pose a formidable obstacle to increasing national COVID-19 vaccination rates in the US, but this is not the first time that American vaccination efforts have confronted resistance and apathy. This study examines the history of US vaccination efforts against smallpox, polio, and measles, highlighting persistent drivers of vaccine hesitancy as well as factors that helped overcome it. The research reveals that logistical barriers, negative portrayals in the media, and fears about safety stymied inoculation efforts as early as the 18th century and continue to do so. However, vaccine hesitancy has been markedly diminished when trusted community leaders have guided efforts, when ordinary citizens have felt personally invested in the success of the vaccine, and when vaccination efforts have been tied to broader projects to improve public health and social cohesion. Deliberately cultivating such factors could be an effective strategy for lessening opposition today, when COVID-19's distinctive characteristics make addressing vaccine hesitancy more urgent than it has ever been.

Headache Triggered by Coronavirus Disease 2019 Vaccination Increases in Line with History of Allergic Disorders and Comorbidities Like Depression and Fibromyalgia: An Analysis of the US Vaccine Adverse Event Reporting System

ABSTRACT Background: Headache is the most common neurological side effect of coronavirus disease 2019 (COVID-19) vaccination. However, the underlying reason for COVID-19 postvaccine headache has not been fully understood. In this study, we addressed the potential association of vaccine-related headaches with a history of allergy, atopic diseases, as well as other comorbid conditions to gain insight about the pathophysiology of this headache. Materials and Methods: This study analyzed the data from the Vaccine Adverse Event Reporting System database and reorganized dataset accordingly. The study included individuals aged 16–85 years who received the first or second dose of COVID-19 vaccines approved by the Food and Drug Administration. Allergy and atopic disease histories (reported food or drug allergy, allergic rhinitis, asthma, and other autoimmune diseases) and other accompanying diseases such as depression, anxiety, sleep disorders, fibromyalgia, and obesity of these subjects were examined from the revised data, and their relationship with COVID-19 vaccine-related headaches was investigated. Results: We found a statistically significant positive association in patients with a history of headache after COVID-19 vaccination and reported a history of allergy (P < 0.001). In the allergy subgroup (n = 14547 [37.1%]), the frequency of headaches following COVID-19 vaccine was found to be higher in those with drug, food, and/or multiple allergies (P < 0.05). A statistically significant relationship was disclosed between asthma, autoimmune diseases, and headache, but no association was found with allergic rhinitis (P < 0.001, P = 0.160). Furthermore, the rate of headaches after vaccination was found to be higher in people with fibromyalgia and depression (P < 0.001, both). Conclusion: Significant associations between headaches triggered by the COVID-19 vaccine and histories of allergy, fibromyalgia, and depression may suggest a shared predisposing mechanism for pathophysiology. Knowledge about allergy history and related comorbid conditions can be helpful in predicting COVID-19 vaccine headache. Future prospective data may provide further enlightenment on management.

Indoor Vaccine Mandates in US Cities, Vaccination Behavior, and COVID-19 Outcomes

Indoor Vaccine Mandates in US Cities, Vaccination Behavior, and COVID-19 Outcomes

Covid-19 vaccine supply chains and the Defense Production Act

Abstract In response to the Covid-19 pandemic, the US government used novel policies to accelerate research, development, and production of a diversified portfolio of new vaccines. This article begins by describing the Defense Production Act (DPA) of 1950 and the initial ‘priority-rated’ contracts agreed to under Operation Warp Speed in 2020 to expedite manufacturing and achieve scale, which succeeded in producing hundreds of millions of doses of Covid-19 vaccines by early 2021. However, a puzzle soon emerged, as the scale of US vaccine production was shortly thereafter overtaken by plants in the European Union and India. The paper investigates the trade-offs US policy-makers faced in early 2021—once much of the initial uncertainty about the safety and effectiveness of many Covid-19 vaccines had been resolved—about whether to recalibrate contracts to expand production capacity to help meet global, instead of US, vaccine demand. It also examines the emergence of input shortages and assesses whether both the price constraints implicit in the 2020 DPA contracts and business decisions made to quicken the process of bringing new vaccine plants online globally inadvertently exacerbated them. It also explores the potential need for complementary, input capacity-enhancing policies in the face of highly fragmented, cross-border Covid-19 vaccine supply chains.

Update From the September 2022 Meeting of the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides expert advice to the Centers for Disease Control and Prevention, normally meets three times per year to develop US vaccine recommendations. The ACIP increased its meeting frequency over the past 2.5 years to address vaccine-related issues during the severe acute respiratory syndrome coronavirus 2 pandemic. They met to discuss updating coronavirus disease-2019 (COVID-19) booster dose recommendations on September 1, 2022 recommending the use of new bivalent COVID-19 booster vaccines which include equal amounts of ancestral and Omicron BA.4/BA.5 variant mRNA that encodes the spike protein.

Манипулятивная риторика вакцинного дискурса (на материале дискурса американских интернет-СМИ)

The issues of linguistic manipulation and misinformation in mass media are of relevance in the context of the COVID-19 pandemic. However, the linguistic means of public opinion manipulation in the news coverage of the COVID-19 vaccines are not sufficiently studied. Therefore, the aim of the research is to identify the rhetorical strategies and linguistic means of public opinion manipulation that are used by journalists in the US vaccine online mass media discourse. Particular attention is paid to the study of such common rhetorical strategies as appeals to the authority of politicians, pseudo-experts and journalists themselves. Scientific novelty lies in taking an interdisciplinary approach to the study of linguistic manipulation mechanisms from the perspective of linguistics, rhetoric and journalism alike. The discourse analysis of the news stories has revealed that the Sputnik V vaccine coverage is politicised, while positive or negative images of the vaccine are mainly created by choosing and using expressive linguistic means and stylistic devices in order to either discredit or promote the image of both the vaccine itself and its producing country.